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Background: Cardiac resynchronization therapy (CRT) is indicated in symptomatic heart failure (HF) patients after achieving optimal medical therapy. However, there are still a large percentage of patients who do not respond to CRT. Malnutrition is a frequent comorbidity in patients with HF, and it is associated with a poorer prognosis. Here, we evaluate the nutritional status of patients assessed by Controlling Nutritional Status (CONUT) score and its association with structural remodeling and cardiovascular events. Methods: We investigated the effect of CONUT on HF/death in 302 consecutive patients with a CRT device implanted between 2005 and 2015 in a single tertiary center. We categorized the patients into three groups: normal nutritional status (CONUT 0–1), mild malnutrition (CONUT 2–4) and moderate-severe malnutrition (CONUT ≥ 5). Changes in nutritional status were assessed in patients with mild-to-severe malnutrition prior to CRT. Results: One hundred and forty-eight patients exhibited normal nutritional status (49.0%), 99 patients exhibited mild malnutrition (32.8%) and 55 patients exhibited moderate-severe malnutrition (18.2%). CONUT scores of at least 2 were associated with higher risk of HF/death compared with CONUT 0–1. Significant left ventricular (LV) reverse remodeling was noted in patients with better nutritional status. In addition, those malnutrition patients at baseline that improved nutritional state exhibited fewer HF/death events at follow-up. Conclusion: CONUT score prior to CRT was an independent risk factor of death/HF and was correlated with LV reverse remodeling. Improvements in CONUT score during long-term follow-up were associated with a reduction in the rate of HF/death. Keywords: Cardiac resynchronization therapy, Heart failure, Malnutrition, CONUT score

Objectives: The aim of the present study was to determine the long-term prognostic value provided by the exercise electrocardiographic (ECG) response to nuclear myocardial perfusion imaging (MPI) in the evaluation of patients with chest pain, focusing on patients with a discrepancy between the two tests. Methods: A total of 1460 consecutive patients (777 female; 62.6±11.4 years) undergoing exercise myocardial single-photon emission computed tomography (SPECT) were included. The endpoint was the occurrence of acute coronary syndrome, heart failure or cardiac death during follow-up. Results: Ischemic ECG changes were observed during stress testing in 271 patients (18.5%) and 362 patients (24.7%) had positive (abnormal) exercise MPI results. There was a discrepancy between ECG and SPECT findings in 471 patients (32.2%). During the follow-up period (14.0-39.6 months), 224 patients (15.3%) presented cardiac events. The hazard ratios (HR) of ECG and MPI results to predict events were 1.506 (95% CI: 1.113-2.039) and 10.481 (95% CI: 7.799-14.080), respectively. In patients with negative MPI, the ECG response did not predict events (HR 1.214 [95% CI: 0.646-2.282]), the same as in patients with positive MPI (HR 1.203 [95% CI: 0.848-1.705]). Only in hypertensive patients with positive SPECT did the ECG show significant prognostic value (HR 1.937 [95% CI: 1.030-3.642]). In multivariate analysis, positive MPI proved an independent long-term prognostic factor (HR 10.536 [95% CI: 7.759-14.308]), but not ECG (HR 1.356 [95% CI: 0.994-1.850]). Conclusion: MPI results (normal vs. abnormal) had strong predictive value and discrepant ECG results had no significant additive prognostic value. Resumo: Objetivos: O objetivo do presente estudo foi determinar o valor prognóstico a longo prazo, fornecido pelo eletrocardiograma (ECG) em resposta ao esforço na cintigrafia de perfusão miocárdica (CPM) na avaliação de doentes com dor torácica, com ênfase para os grupos de doentes com discrepância entre os dois testes. Método: Foram incluídos 1460 doentes consecutivos (777 do sexo feminino; 62,6 ± 11,4 anos), submetidos a exercício na cintigrafia de perfusão miocárdica com SPECT. O endpoint foi a presença de síndrome coronária aguda, insuficiência cardíaca ou morte cardíaca durante o seguimento. Resultados: Duzentos e setenta e um doentes (18,5%) apresentaram alterações eletrocardiográficas de isquemia durante o teste de esforço e 362 doentes (24,7%) tinham resultados positivos (anormais) na CPM. A discrepância entre os resultados do ECG e CPM apareceu em 471 doentes (32,2%). Durante o período de seguimento (14,0-39,6 meses), 224 (15,3%) apresentaram eventos cardíacos. O hazard ratio (HR) para predizer eventos dos resultados do ECG e CPM foi de 1,506 (1,113-2,039) e 10,481 (7,799-14,080), respetivamente. No grupo de doentes com CPM negativo, o ECG não prediz eventos [HR 1,214 (0,646-2,282)],e o mesmo acontece no grupo de doentes com CPM positivo [HR 1,203 (0,848-1,705)]. Apenas em doentes hipertensos com CPM positivo, o ECG mostrou valor prognóstico significativo [HR 1,937 (1,030-3,642)]. Na análise multivariada, a CPM positiva foi um fator independente de prognóstico a longo prazo [HR 10,536 (7,759-14,308)], mas não o ECG [HR 1,356 (0,994-1,850)]. Conclusão: O resultado da CPM (normal versus anormal) teve um forte valor preditivo e o resultado discrepante no ECG não teve um valor prognóstico adicional significativo. Keywords: Electrocardiogram, Myocardial perfusion imaging, Stress test, Prognosis, Palavras-chave: Eletrocardiograma, Imagens de perfusão miocárdica, Prova de esforço, Prognóstico